UNITED KINGDOM

Health Protection Agency

1992 HPA Guideline: Handwashing in Primary Schools

Excerpt from a guideline of the ‘recommended technique’ of handwashing in primary schools. Based on Ayliffe GAJ et al. Control of hospital infection; a practical handbook. 3rd ed. Chapman and Hall, London, 1992.

“Handwashing is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea and vomiting, and respiratory disease. The recommended method is the use of liquid soap, water, and paper towels.”

2009 HPA Hospital infection control guidance

From the introduction: “This document intends to give infection control and other general guidance to those personnel who may be involved in receiving and caring for patients who may have SARS, primarily within acute healthcare settings, and should be used in conjunction with local policies.”

2011Health Protection Agency Northwest: Infection Prevention and Communicable Disease Control Guidance for Early Years and School Settings

From the introduction: “Nurseries and schools are an ideal environment for the spread of infection and infectious diseases. Young children, in particular those who attend nurseries and pre-school facilities, may be more susceptible to infection and infectious diseases…This guidance document provides you with information on the prevention and control of infection within a nursery, pre-school or school setting.”

“Dry hands thoroughly on disposable paper towels.Cotton (terry) towels are not recommended for general hand hygiene. Children will share towels (even if they are instructed not to do so) and this can be an excellent way of spreading infection. Even if each child has their own towel with their name on it, the risk of sharing is high, increasing the risk of cross-infection. Hot air hand dryers are not suitable for nurseries and schools. In a nursery, pre-school or school or school setting the only satisfactory method of drying hands is with good quality disposable paper towels.”

This document establishes what Essex calls “Standard Principles of Infection Control (or Universal Precautions).” From the introduction: “The recommendations on standard principles provide guidance on infection control precautions that should be applied by all healthcare personnel, and other carers, to the care of patients in community and primary care settings. Everyone involved in providing health and social care should know, and have a duty to apply the standard principles of hand decontamination, the use of protective clothing and the safe disposal of sharps.”

This is an essential part of hand hygiene. Dry hands thoroughly using good quality paper towels. In clinical settings, disposable paper towels are the method of choice because communal towels are a source of crosscontamination. Store paper towels in a wall-mounted dispenser next to the washbasin, and throw them away in a pedal operated fire-retardant domestic waste bin. Do not use your hands to lift the lid or they will become recontaminated.

Hot air dryers are not recommended in clinical settings. However if they are used in other areas, they must be regularly serviced and users must dry hands completely before moving away.”

2000 UK Health Protection Agency’s Newsletter for Schools

An update sent to schools following an outbreak of infections among children of ‘itchy skin infections.’

“Impetigo.

[…] Schools can also help prevent the spread of infection by ensuring that children do not share personal items such as towels, and roller towels in wash areas are replaced by driers or paper towels. The single most effective method for controlling the spread of infection is by frequent and thorough hand washing. A supply of hot and cold water, soap and single-use hand-drying facilities (such as paper towels or hot air dryers) should be provided for children and staff.”

2010 Guidelines for the Control of Infection and Communicable Disease in School and Early Years Settings

From the South West London Health Protection Unit

“Drying hands

Disposable paper towels are recommended for drying hands, as re-usable towels are often damp and can harbour germs and re-contaminate hands. Drying hands thoroughly after washing is important as wet surfaces transfer micro-organisms more effectively than dry ones. It is suggested that paper towels rub away more germs that are loosely attached to hands. Ineffective drying may also lead to skin damage. Warm air hand dryers are generally not recommended as they blow germs back onto the hands, they take longer to dry hands than paper towels, people often do not spend long enough using the dryer and they can only serve one person at a time. However, if roller towels or air dryers are used, then they must be maintained regularly. Roller towels must be replaced frequently. Cloth/cotton towels/tea towels should not be used as they allow recontamination of the hands.”

IRELAND

The Irish Health Service provides this indication:

“Good quality disposable paper towels should be used in clinical areas. Hand dryers are not advised as they usually result in a longer time for complete hand drying. (hence result in poor practice), only allow one-person use at a time, and require maintenance.”